MaineCare Billing Specialist

Overview

MT. BLUE REGIONAL SCHOOL DISTRICT - RSU 9 227 MAIN STREET, FARMINGTON, ME 04938
• Phone  
• Fax

Community Culture Curriculum

“Working together to provide high-quality educational opportunities for all.”

Location/Regions: CHESTERVILLE - FARMINGTON - INDUSTRY - NEW SHARON - NEW VINEYARD - STARKS TEMPLE - VIENNA - WELD - WILTON

Position: Maine Care Billing Specialist

Department: Special Education - District Office

Job Goal
:
The Maine Care Billing Specialist position is responsible for coordinating with third party billing programs, Maine DHHS, Maine DOE, administration and staff to optimize the efficient and accurate submission of Maine Care Billing for all school-based billable services. The Billing Specialist must monitor the timely submission of authorizations, treatment plans and ensuring IEPs are current. Maintenance in the MIHMS portal and ongoing monitoring for Maine Care eligibility of students is also required.

The Billing Specialist understands and works with Electronic Health Records including the portal within which these records are generated.

Qualifications

• One year experience in health care billing. Experience in the mental and behavioral health care industry preferred
• Experience with computerized billing systems, spreadsheets and word processing programs
• Strong oral and written communication skills

Certifications

• Valid CHRC - Maine DOE Background Check
• Go to https://(Use the "Apply for this Job" box below). for instructions on how to create an MEIS account
• Register at  to make your fingerprints appointment. ($55 fee)
• Submit a new application for CHRC. ($15 fee)

Performance Responsibilities

• Check Acentra and Health Pas (MIHMS) daily for new Prior Authorizations and/or Continued Stay Reviews. Record new authorizations in Therap.
• Monitor authorization dates to minimize lapses in payment.
• Communicate with staff regarding upcoming due dates for timely submission.
• Check Unposted Sessions Summary Report (Acuity) monthly and contact providers who are behind in posting and missing student information (e.g., ICD-10 codes).
• Provide monthly Provider reports to administration with provider activity information (Hours/sessions/unposted).
• Review non-billable & missing information reports from EDMS and communicate to providers items to correct for OT, PT and ST.
• Monitor Authorization and ITP/ISP expiration dates, communicate with Clinicians to ensure there is not a lapse in billing eligibility.
• Understand, manage, and coach providers in the use of Electronic Health Records.
• Communicate with EDMS and Therap to solve any difficulties staff may have.
• Distribute instruction material, organize training, etc. as needed.
• Provide EDMS with rate sheets for OT, PT and SL.
• Collect and file signed Statement of Reassignment forms.
• Collect signatures and file signed Electronic Signature Verification forms.
• Assist staff with registration for BHP training. Collect and file BHP certificates and service provider licenses.
• Collect and record Parental Consent for Maine Care Billing.
• Monitor Student Maine Care eligibility.
• Communicate with staff to ensure all Sessions/ISP Data are completed in a timely manner so billing can occur.
• Submit claims (837 transactions) to MIHMS weekly.
• Post Maine Care payments (835 transactions) received to Therap.
• Send monthly reimbursement reports to the Finance manager.
• Research/resubmit denied and/or suspended claims.
• Update Therap by adding/discharging students and staff.
• Review SEED Payment Report quarterly through NEO.
• Maintain Provider information in the MIHMS portal.
• Update rates and modifiers as needed.
• Add new staff accounts to Therap and Acentra.
• Check monthly for late documentation and send claims.
• Maintain strict confidentiality.

Education

• High School Diploma required. Associate’s Degree in business or significant related training and experience preferred

Working Schedule

• 260 days (Fulltime - Year Round)
• 30 hours/week, additional hours may be available
• Earned vacation and sick time

Travel Requirements

• Travel between schools or district buildings may be required for certain positions

Reports To
:
Director of Special Services or their designee

Terms of Employment
:
This is an at-will position not governed by a collective bargaining unit and employment is determined annually by the District.

Evaluation
:
Completed annually by Director or their designee.

FLSA Status
:
Non-exempt

Note
:
The above job description reflects the general requirements necessary to describe the principal functions or responsibilities of the job identified and shall not be interpreted as a detailed description of all work requirements that may be inherent in the job, either at present or in the future.